Basic patient care (what does a nurse do?)

Evelyn_Alexie

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I have a scene where the heroine wakes up in an a hospital room. (She'd been brought in unconscious the night before. No broken bones, just a cut on the head.) A nurse walks into the room. What does the nurse do? Take her pulse? Ask her if she needs a bedpan/help walking to the toilet? Something else?

I just need the nurse to do /something/ while she talks with the heroine and sets the scene for the hero to walk in.

I'm not having luck with Google or searching the forum. The question is too basic, too ordinary perhaps?

I'd always considered it a good thing that I've made it this far in life without having to spend any time in a hospital room. But now, I'm seeing the drawbacks :(
 

Twick

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Never been in the situation, but I'd imagine with an unconscious patient, the nurse would come in to check vitals, as well as equipment such as heart monitor or IV. Being unconscious is pretty serious, so there would be lots of monitoring I'd assume.
 

Evelyn_Alexie

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Yes, she'd had a concussion (I relied heavily on the wonderfully useful Concussion thread for that scene). Now, she's woken up in the hospital and is trying to remember how she landed there.

Would the nurse take her pulse perhaps? Or just go notify a doctor who can flash nasty bright lights in her eyes?
 

DeleyanLee

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This can happen in an ER room or an inpatient room, FWIW.

When she woke up, she would already be attached to a heart monitor (attached to various points on her torso), she would have a pulse ox on a fingertip. There would be a monitor to one side of her bed, likely quietly beeping along with her heartbeat. She, of course, will be a hospital gown. She will likely have had a CT scan of her head to make certain there's no brain damage because of coming in unconscious. Odds are she wouldn't have a bedpan and would be assisted to the toilet if she had to go because she was just unconscious.

She might have someone sitting with her. Many hospitals have (or have had, they did when I worked for them, back in the day) volunteers who will sit with patients who need to be monitored. It frees up the nursing staff. Generally, sitters will bring a book, homework (if they're college students) or might by playing something on their phones to pass the time while they wait. That sitter would have the nurse call and would signal for staff to come in if she wakes up.

That might be enough for your scene for your hero to come in on, but then a nurse would interrupt them to see how she's doing. A nurse would also notify the doctor, who would have to come in and do a more thorough exam.

Is there some reason why the hero can't be sitting with her when she woke up?
 

talktidy

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Well, when I was in hospital (UK NHS), the nursing staff measured my temperature, my blood pressure and blood oxygen saturation levels every day at intervals from morning till evening. I was hooked up to a heart monitor, too. They repeated these checks immediately before and after I had a stent fitted. At no stage, however, had I been unconscious.

I have no medical training, but I would expect the nurse to pass the word the patient was conscious and then perform those checks for the benefit of the doctor whenever they arrived.

If the patient was unconscious, would they not catheterise them? Medical staff seem pretty keen on measuring what goes in (drip) and what comes out (urine) to assess kidney function.

Again no medical training, but I understand there are different levels of unconsciousness, which would determine how the medical staff would treat the patient.

A friend of mine was mugged by two arseholes on his way home from the pub. They clubbed him on the head with a brick. He was lucky to avoid long term consequences like epilepsy, so be aware of this.
 

waylander

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Where is this set? Nurses have quite different duties in different countries
 

Evelyn_Alexie

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It never occurred to me that the hero could be sitting in the room with her! The only time I visited a sick relative in the hospital it was in the ICU, and we only had a limited amount of visiting time allowed.

This scene is set in the U.S. It's a small hospital in a small town out in the desert.

Do hospitals catheterize unconscious people as a rule? Another thing I did not know. It's the questions you don't know to ask that trip you up the most. Thank you all!
 

Siri Kirpal

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If the hero isn't in the room with her, then what the nurse would probably do first thing is ask how she was doing and ask if she needed help to the toilet (unless she's on a catheter, can't answer that question). The nurse would probably also check to see if her IV was in good shape.

Blessings,

Siri Kirpal
 

neandermagnon

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There's specific neurological tests that they do if you've had a concussion. You'll probably need to ask a nurse or doctor what they are. On the NHS they're done by nurses (then referred to the appropriate specialist doctor if the results are bad). My daughter had a concussion and she had to do all these odd tests before she was allowed to go home (this was in A&E, she wasn't admitted). My other daughter was once kept in overnight after a suspected concussion (she was very young so they were more careful) and the nurses checked her neurological signs every hour through the night. For a sleeping patient, this can be done without fully waking them up. They use the Glasgow Coma Scale (aka GCS) to evaluate patients, but this only measures a patients level of consciousness - there are other neurological things they test for as well.

Bear in mind that a patient who has been unconscious for a long period of time (e.g. hours) would be in the intensive care unit, not a normal hospital ward. If they've really been unconscious (GCS of 3) for that long the nurse isn't just going to say "hi" and see if they need to go and use the toilet. I'm not sure that patients would go straight from GCS 3 to GCS 15 (fully conscious) just like that. However, if you don't want her to have that severe a concussion and be in a normal ward, then maybe she was unconscious for a short time (seconds or minutes), regained consciousness but after evaluation wasn't deemed well enough to go home so was kept in overnight for observation*. A sleeping patient who can be roused normally would have a GCS of 15 (equivalent to fully conscious) and as said above this can be assessed without fully waking the patient. If there's been no concerns with her overnight then her waking from sleep and being fully alert and not needing that much specialist care/assessment from the nurse is fine. The nurse would still have to do all the neurological test/observations in any case so you'd need to check exactly what a nurse would do.

*you'll need to check what sort of issues she'd be having, but probably things like still being in a bit of a daze, not fully conscious/responsive, GCS quite high but less than 15... bear in mind that I'm not a doctor or nurse and you'd need to check the finer details with a doctor or nurse. Also, I don't know if GCS is just a UK thing of if it's used worldwide. The NHS and other emergency services here all use it.

I realise I've only sort of half answered your question but hopefully it's pointing you in the right direction at least. It's one of my pet peeves where characters are unconscious for hours (or even days) with doctors acting like they're just sleeping and them waking up like it's all totally normal and nothing much happened. GCS of 3 for a prolonged period of time is a very serious red flag. People can and do make a full recovery from severe head injuries but it's still a very big deal and requires a lot of medical care and it may take a while for them to function normally again.
 

WeaselFire

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Keep in mind that, in general, if a patient is not conscious they will be in an intensive care area or the emergency room. They need special monitoring.

Now for my (multiple, unfortunately) experiences with this, I was hooked up to a monitor for heart rate, oxygen levels, etc., had a catheter in me so no need to urinate, had an IV drip running fluids or medications and was in full view of a nursing station at all times, even if they ignored me for most of it. I would have limited visitors for limited times but no one was ever there when I woke up. Possibly shortly afterward. I make a poor conversationalist when I'm on a respirator though. :)

Now, in ICU, emergency room or a private or semi-private room, the nurse would check vitals on the monitors, change IV bags as needed, check bandages/sutures/etc., dispense medications through the IV or an injection (diabetic, blood sugar tested with finger stick and insulin in the abdomen as required...). Rarely did they just converse with me at this stage but they would ask questions like "How's your pain level?" or "Are you warm enough, do you need a blanket?"

Once in a room, there would be routine rounds, meal services, assistance to the rest room or shower if needed, prep for an orderly to push me to some room full of expensive medical equipment for one test or another, sometimes a portable X-ray, and hygienic duties like sponge baths, teeth, etc. We had short conversations then, about a myriad of things, and they would update me on doctor's visits and so on. In the room I would have one or two visitors with me during most of the day. When you're in for a serious or terminal issue, there are no visiting hours.

If you really want excitement, put your character in a teaching hospital so student nurses and doctors parade through. :)

Jeff
 

Orianna2000

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Never had a head injury, but the most recent time I was hospitalized was for pneumonia and pleurisy, with heart complications. A nurse came in several times a day to take my blood pressure and check respiration, O2 stats, etc. Also, once a day, a nurse (or orderly?) would come in to change the sheets. I had to get out of bed for this. This person also asked me whether I'd showered or not, which was especially dumb because I was quite dizzy and couldn't even stand next to the bed without holding on. I wouldn't have trusted myself in a shower, even one with a safety bar to grab. They knew this, but no one offered to help me shower. I finally had my husband bring in some of those Cottonelle wipes, so I could give myself a pseudo-sponge bath.

They are a bit trigger-happy with catheters. When I was admitted with pneumonia, they kept trying to give me a catheter. I was fully capable of walking to the bathroom, so long as I could hold onto the IV pole, but they kept insisting that a catheter would allow me to relax and not have to worry about getting up to pee. Obviously, they didn't know me well.